Organization Organization Name Address
Submitting Person Name
Title Contact Phone Email
Details of Funding Request Program Name Annual program budget Requested grant amount Time period during which funds will be used Organizational Due Diligence
Answer the following questions; if any are not applicable, state why. Year founded Quote your mission/purpose statement Target Population
Whom does the organization serve? Describe the target population as tightly as possible in demographic and geographic terms. What characteristics do they have that results in their needing services from your organization? (Use less than 50 words.)
What is the strategy your organization uses to achieve your mission? At the highest level, how do you achieve your mission? (Use less than 50 words.)
Programs & Products
Very briefly list the specific programs, products, or services you offer to carry out your strategy.
General Program Effectiveness
Using concrete numerical terms, describe your organization’s major accomplishments towards achieving its mission for a recent 12-month period. (Please provide the dates for the 12-month period you use. Then, provide a bulleted list of organizational outputs for the time period indicated. If exact numbers are not available, give an estimate.)
State the organization's purpose clearly in terms of desired outcomes. What changes do you seek to achieve in the lives of the persons you serve? Changes may be in behavior, skill, knowledge, attitude, or situation. (Outcomes do not need to be quantified; use one sentence for each.)
If you measure outcomes, state what outcomes you measure and, if available, the statistical results for each outcome. (One sentence each; use the same numbered points as prior question so they match. If an outcome is not measured, so state.)
Number of board members
Number of independent board members-not an employee or related by blood or marriage to another board member or employee
Frequency of meetings
Describe what the board does. For example, it may approve an annual budget, or review the performance of the CEO, or provide volunteer service, or do fundraising, etc.? (Use less than 100 words.)
Describe the level of involvement of board members. For example, how active are they in board and committee meetings? How regularly do they attend board meetings? How involved are they in directing strategy, setting goals, approving the budget and major decisions, fundraising, shaping strategic initiatives, etc.? (Use less than 100 words.)
Leadership, Management, & Human Resources
Briefly describe the qualifications of the senior executive leading the organization (education, experience, certifications, etc.). When did he/she start working with the organization? (Use less than 50 words.)
Number of fulltime staff
Number of part-time staff
Planning & Resource Allocation
Do you prepare an annual budget?
Do you have a written strategic or operating plan? If "Yes", when was it last updated?
Do staff or departments have measurable goals?
Frequency with which financial statements are prepared for senior management
Frequency with which financial statements are provided to board members
Does an outside accounting firm perform an annual audit?
Marketing & Communications
Do you create an "Annual Report"? If "Yes", who receives it?
If you differ from other organizations with a similar mission to serve similar clients, state how you differ. (Use less than 100 words. If you do not differ significantly, leave blank.)
Legal & Risk Management
Does the organization have proof of professional liability insurance? If "Yes", policy expiration date?
Legal relationship with any other legal entities
Has the organization been involved in a lawsuit, mediation, or arbitration in the past? If "Yes", explain briefly.
Is there currently any complaint, investigation, lawsuit, or potential lawsuit initiated by the IRS, a government agency, the board or a director, a donor, client, business partner, supplier, employee, or anyone else? If yes, please explain briefly.
Compile copies of the following documents and upload them below. These documents are not required if you have provided them to the Foundation within the past three years ( see Grant Proposal Process for proposal instructions).
Certificate of incorporation
Articles of Incorporation
Letter of exemption from IRS granting 501(c)(3) status
Most recent Annual Report (if available)
List of board members with their vocation and place of work (if applicable)
Most recent year-end financial statements, including a Statement of Activities (Profit & Loss Statement) and Statement of Financial Position (Balance Sheet), audited if available
Most recent fundraising letter/email
If you do not have an item or do not include one, briefly state why it is not included. The Foundation does not require that applicants create any of the following documents, only that copies be provided if they already exist—many small organizations, and some large ones, do not have all the items requested.
Upload supporting documentation Request to Support a Program Program
Name and Year started
Program Target Population
Describe the target population for the program as tightly as possible in demographic and geographic terms. What characteristics do they have that results in their needing services from your organization? (Use less than 100 words.)
What is the problem that the target population has that your program addresses, and what solution do you offer to this problem? (Use less than 100 words.)
What strategy does your program use to bring a solution to your target population? (Give a “high level” answer in 1-2 sentences. You can provide details later under “Program Description.”)
Describe the program in some detail, stating what you do and how it works.
State as precisely as possible the changes that you seek to achieve in the lives of the persons you serve with this program. List about 3-5 changes you expect as people participate; changes may be in behavior, skill, knowledge, attitude, or situation. (Use one sentence for each outcome.)
As best as possible, state the amount of each outcome you achieve with your program. You may report on prior outcomes achieved or predict future outcomes—clearly differentiate data differences such as these. Statistics could be per year, per event, per person served, or some other unit of measurement that works for your program. Use the same outcomes and numbering system as above. (Use one sentence for each. If you don’t know the degree to which outcomes are achieved, so state and explain the program’s effectiveness in other terms.)
Program Leadership & Personnel
Describe the qualifications of the program director (education, experience, certification, etc.). If program director is same as executive director, simply say so (use less than 50 words).
Number of fulltime program staff
Number of part-time program staff
Partnerships & Collaboration
If the program relies on partnerships or collaboration with other organizations, describe the nature of the partnership.
Attach an expense budget for the program. Make clear the time frame for the budget, and provide a moderate level of detail. Do not embed any overhead costs in the line items; if you wish to include overhead, show your typical overhead items on their own lines (e.g., rent, utilities, supplies, allocation of management salaries, etc.). Feel free to provide short explanatory notes if desired.
In addition, list all known and hoped-for funding to cover the expense budget. Clearly differentiate between known/available funding and anticipated funds that are not yet secured. The total income must match the total expenses. Feel free to provide short explanatory notes if desired (e.g., if your “funding” includes in-kind gifts or a government grant).
Amount requested from Georgia's Own Foundation, Inc. (state dollar amount and percentage of program budget it represents): $XX (Y% of total budget of $ZZ)
Affirmation & Covenant *